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AAP revises circumcision policy, says benefits outweigh risks

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How is the American Academy of Pediatrics (AAP) revised policy on circumcision different from its previous stance?

In 1999, the AAP neither recommended nor discouraged circumcisions based on health reasons. The new 2012 AAP statement is more of an “encouragement” for newborn boys in the United States to get circumcised.

Why has the AAP revised its circumcision policy?

Back in 1999, the AAP found that there was not enough of a health benefit to perform routine neonatal circumcision. Now, in 2012, they have found enough evidence to say there is some benefit. Also, in 1999, the AAP put the bulk of decision making in the hands of the parents. They were asked to put aside beliefs of health benefit, and to weigh their decision based more on religion, culture, social or family reasons. The new policy statement still puts the decision making in the parents’ hands, but the policy now says there is some medical benefit that parents should consider.

Have recent studies shown advantages or disadvantages for circumcision?

Marvin Wang, MD

The updates in medical literature on circumcisions and later problems in life haven’t changed too much since 1999, with perhaps the major exception of HIV research. We have found that being circumcised is associated with a 50 percent decreased risk of acquiring the virus. This has been known in Africa for several years now (where the studies were done). Since then, there is now anecdotal evidence implying that the HIV rate among circumcised men is going up. The implication is that circumcised men somehow have a false sense of security, believing that the circumcised state will shield them from HIV, and thus, are less inclined to practice safe sex.

How will the AAP’s revised policy affect parents and medical professionals?

A large part of this statement advocates for access to unbiased parental education, in the early part of pregnancy, to give parents plenty of time to consider their options. As well, because of the potential medical benefits, financial barriers should be removed that might prevent parents from getting a child circumcised. This mostly refers to the 15 states whose state Medicaid programs have stopped paying for circumcisions. The rest of the technical statement gives similar recommendations to its previous incarnation, which advocates for trained people to perform it, and that it be done with proper anesthesia.